Gut Talk

In this special crossover podcast episode, Tuesday Night IBS host Jeffrey Roberts, MSEd, BSc, and Kate Scarlata, MPH, RDN, are joined live by William Chey, MD, and Amanda Lynett, MS, RDN, at FOOD the Main Course Conference in Ann Arbor, MI.

·       Intro :02

·       The interview/about Scarlata :27

·       About Chey 1:07

·       About Lynett 1:53

·       Chey, over the course of your career, what prompted this area of interest for you? 2:47

·       When did you first hear about FODMAPs in relationship to IBS, and was there an “a-ha” moment that made you think that this would become something major in the future? 5:38

·       What was your goal with this conference, FOOD the Main Course?  10:28

·       Amanda, how do you go about putting a conference like this together?  14:09

·       Where do you see GI nutrition going? What are some new updates in this area for dieticians? 18:45

·       Amanda, what personally prompted you to go into GI nutrition? 22:03

·       Chey, where do you think IBS care is going, and are we succeeding in helping patients? 24:37

·       Do you feel that there is a role for supplements, prebiotics and probiotics in managing IBS? 28:26

·       What about mast cell stabilizers? 30:49

·       Do you have any recommendations right now for health care providers caring for patients with IBS? 33:56

·       Do you think there is an opportunity to educate providers about pelvic floor physical therapy from a diet and awareness perspective? 39:21

·       Amanda, as an expert GI RD, where do you see IBS care going, and what hopeful messages can you provide to people living with this condition? 42:41

·       If you could speak to other health care professionals that work in GI, what is an important component that should be considered when offering nutrition care for patients living with a GI disorder? 44:17

·       Thank you, Dr. Chey and Amanda 49:26

·       Thanks for listening 49:42

Amanda Lynett MS, RDN, is a registered dietitian with her masters. Amanda is with the Division of Gastroenterology at Michigan Medical in Ann Arbor.

Jeffrey Roberts, MSEd, BSc, is a patient advocate and creator of the first website for IBS sufferers. He is the co-founder of Tuesday Night IBS.

Kate Scarlata, MPH, RDN, is a US-based dietitian with over 30 years of experience. Kate’s expertise is in gastrointestinal disorders and food intolerance.

We’d love to hear from you! Send your comments/questions to [email protected]. Follow us on X @HealioGastro @sameerkberry @umfoodoc. For more Tuesday Night IBS, be sure check out TuesdayNightIBS.com and to follow and subscribe to their podcast.

Disclosures: Chey and Roberts report no relevant financial disclosures. Scarlata reports stock options with Epicured LLC and FODY Food Company, financial support from Dr. Schar, Mahana Therapeutics, Nestle Health Science, Olipop, Pendulum, QOL Medical.

In this podcast episode, Tom McCourt, chief executive officer of Ironwood Pharmaceuticals, discusses the evolving relationship between physicians and pharma, breakthroughs in GI drugs and more. •    Intro :59 •    Welcome to this episode of Gut Talk 1:23 •    The interview/about McCourt 1:32 •    Tell us about your family and where you grew up. 2:15 •    What did you take away from your football career at University of Wisconsin? 4:19 •    How long were you a clinical pharmacist?  7:57 •    McCourt on his experience as a health science associate.  8:55 •    Where is the line between academics and the pharma industry? 10:49 •    When you launched drugs like omeprazole and esomeprazole, did you have any idea what impact they would have? 13:00 •    What changed to make the pharma industry go from respected to villainized? 16:39 •    What’s your perspective on innovation and billing architecture for pharmaceuticals? […] Where do you think we’re going to see the most exciting changes in the near-term? 19:33 •    Chey and McCourt on challenges the US health care system faces in comparison to other countries. 24:47 •    How can we make breakthrough drugs and technology available to everyone without stifling innovation? 27:05 •    Did patients valuing their quality-of-life factor into your decision to switch from AmGen to Ironwood Pharmaceuticals? 29:12 •    From a pharmaceutical perspective, do you think there are examples of successful health policy? 36:30 •    Thank you, Tom 42:13 •    Thanks for listening 43:20 Tom McCourt is the chief executive officer of Ironwood Pharmaceuticals, a commercial biotechnology company working to revolutionize the treatment of gastrointestinal (GI) diseases and redefine the standard of care for millions of patients.  We’d love to hear from you! Send your comments/questions to [email protected]. Follow us on X @HealioGastro @sameerkberry @umfoodoc. For more from McCourt, follow @ironwoodpharma on X. Disclosures: Berry and Chey report no relevant financial disclosures. McCourt is chief executive officer and a member of the board of directors of Ironwood Pharmaceuticals; serves on the board of directors and member of the compensation committee of Pliant Therapeutics, Inc., a public company, and on the board of trustees for the American Society of Gastrointestinal Endoscopy (ASGE).    

In this podcast episode, John Inadomi, MD, chair of the department of internal medicine at University of Utah Health, discusses the value of mentorship, qualities a leader should possess and more. •    Intro :59 •    Welcome to this episode of Gut Talk 1:23 •    The interview/about Inadomi 1:30 •    Tell us about your family and where you grew up. 2:59 •    Inadomi on the impact World War II had on his family. 3:47 •    Chey and Inadomi on the ways immigrants approached being American post-World War II. 4:33 •    How did you end up in medicine after receiving a mechanical engineering degree from MIT?  6:32 •    How did you go from bionics to polyps/GI? 8:00 •    What did you learn from your experiences playing water polo in college? 10:31 •    How did you end up at the University of New Mexico? 13:00 •    What did Amnon Sonnenberg, MD, MSc, teach you? 16:04   •    How do you view and embrace change? 18:27 •    When did you catch the bug of wanting to lead faculty? […] Did you have mentorship specifically on health system leadership? 24:30 •    How have you learned these leadership characteristics and skills that are not an inherent part of physician training? Do you think there is going to be a change in leadership development moving forward? 29:59 •    For people thinking about advancement opportunities in leadership, what is the mindset you have to develop as a successful division chief or a successful department chair? 33:55 •    What do you think are the biggest challenges facing academic gastroenterology or academic internal medicine? […] How can we physicians be aware of and mitigate these challenges? 38:36 •    How are academic medical centers going to survive?  41:39 •    Do you see the loss of physician autonomy and burnout getting better? 43:29 •    What has been your favorite golf course that you have played on? 46:36 •    Thank you, John 47:48 •    Thanks for listening 48:14 John M. Inadomi, MD, is the Jon M. Huntsman presidential endowed chair, and the chair of the department of internal medicine at University of Utah Health. We’d love to hear from you! Send your comments/questions to [email protected]. Follow us on X @HealioGastro @sameerkberry @umfoodoc. For more from Inadomi, follow him on X @InadomiJ. Disclosures: Berry and Chey report no relevant financial disclosures. Inadomi reports grant support from Exact Sciences.

In this podcast episode, Tom Shehab, MD, managing partner at Arboretum Ventures, discusses supporting “doctorpreneurs”, alternative career paths for physicians and more. •    Intro :59 •    Welcome to this episode of Gut Talk 1:23 •    The interview/about Shehab 1:30 •    Where did you grow up and who were your early influences? 2:02 •    Can you give us some examples of your parents’ sacrifices that made your career possible? 3:19 •    What did you learn from being an athlete and your time playing football at Bowling Green State University? 4:38 •    Tell us about your education.  6:21 •    How did you make the move from an academic career to venture capitalist? 7:03 •    What can you teach our audience about paving this path? 10:55 •    Is it better to thoughtfully consider major career decisions and changes, or just leap before you look? 12:45 •    What other advice would you give budding “doctorpreneurs”? 14:35   •    How are GI and liver a space for venture investment? 18:01 •    Outside of endoscopy, why is there a dearth of information in the GI specialty from a venture perspective? 21:36 •    Do you see this changing in the right direction toward GI specialists paying more attention on what needs attention and expertise, or are macroeconomic incentives preventing us from taking that perspective? 24:37 •    What advice do you have for someone who is thinking about an alternative career pathway? 33:08 •    What is the next step or time commitment for aspiring “doctorpreneurs” with ideas? 37:26 •    What about the venture world? How should physicians go about funding and investing in their ideas?  41:33 •    What are some of the upcoming macroeconomic trends that will impact GI in the short- and long-term? 46:47 •    Thank you, Tom 52:02 •    Thanks for listening 52:55 Tom Shehab, MD, practiced medicine for 15 years as a gastroenterologist serving as chair of medicine at Integrated Health Associates (IHA), and as chief of staff at St. Joseph Mercy Hospital for more than 1,000 physicians. Shehab currently serves as a board director for Avation Medical, Boomerang Medical, Fifth Eye, Motif Neurotech, SonarMD and Virtual Incision and led Arboretum’s investment in nVision Medical, which was acquired by Boston Scientific in 2018. Shehab also serves as a board member for several health care innovation initiatives, including the Cleveland Clinic Medical Device Advisory. He is also on the board of trustees for Bowling Green State University.

We’d love to hear from you! Send your comments/questions to [email protected]. Follow us on X @HealioGastro @sameerkberry @umfoodoc. For more from Shehab, follow him on X @TomShehabMD.   Disclosures: Berry, Chey and Shehab report no relevant financial disclosures. 

In this podcast episode, Megan Riehl, PsyD, discusses symptoms and solutions in GI psychology, building educational tools for patients and physicians on GI psychology and more. •    Intro :02 •    Welcome to this episode of Gut Talk :23 •    The interview/about Riehl :33 •    Riehl on early influences on her career. :48 •    Growing up, how did your family system influence you? 2:12 •    How did you get into psychology, and who were the people that influenced you to go into this field? 3:45 •    How did you become interested in GI psychology?  5:27 •    Chey and Riehl on risk-taking behavior and building the GI psychology program at Michigan. 7:29 •    Were there other fields you were considering as a subspecialty in psychology? 10:23  •    Is there something physiologic about gastroenterology that makes the path to psychology more appropriate than other specialties in the health care system? 13:33 •    Can you explain the difference between a GI psychologist and a general psychologist, and what types of patients will benefit most from GI psychology? 16:12   •    Do you get inappropriate referrals from clinicians, such as patients with compliance and adherence issues or lack of belief in the validity of their diagnosis? 19:33 •    Do you think the term ‘GI psychologist’ is limiting, and have you thought of different words or terminology we can use to refer to this type of work? 22:20 •    Berry, Chey and Riehl on potential benefits, risks and the impact of digital therapeutics on behavioral health. 24:37 •    Berry and Riehl on the issues facing patients’ ability to access GI psychology, and how digital therapeutics can potentially address these issues. 28:04 •    What are the main types of interventions in GI psychology, and what do they do? 31:48 •    Riehl on her upcoming book, Mind Your Gut: The Whole-body, Science-based Guide to Living with IBS, co-written with Kate Scarlata, RDN. 36:09 •    Thank you, Megan 38:40 •    Thanks for listening 38:55 Megan Riehl, PsyD, is a GI psychologist with expertise in psycho-gastroenterology and the management of GI conditions. She is the clinical director of the GI behavioral health program at the University of Michigan, where she has a full-time clinical practice, leads GI behavioral health trainings and provides peer consultation. We’d love to hear from you! Send your comments/questions to [email protected]. Follow us on X, formerly known as Twitter, @HealioGastro @sameerkberry @umfoodoc. For more from Megan, follow @DrRiehl on X, formerly known as Twitter.  Disclosures: Berry and Chey report no relevant financial disclosures. Riehl reports she is a co-parent owner of GI OnDemand with Gastro Girl, Inc.

In this podcast episode, Kate Scarlata, MPH, RDN, discusses how to help patients avoid over restricting their diets, the use of digital therapeutic tools in dietetics and more. •    Intro :02 •    Welcome to this episode of Gut Talk :23 •    The interview/about Scarlata :31 •    Scarlata on her family and growing up in a family of nine children. 1:02 •    Who was more influential in shaping you? Was it your family, or people outside the family unit? 3:40 •    What got you interested in diet and nutrition? 6:27 •    Are there any defining moments personally or professionally that affected the direction of your career?  8:02 •    Can you tell us about your first job as a GI dietician and how it led to your role in the field today? 12:17 •    Berry and Scarlata on GI patient motivations and how they differ from the average patient. 16:51  •    Are there things that you think are unique from a dietetics perspective to build that rapport with the patient and walk them back from deeply rooted thoughts they may have about their diet? 17:49 •    Have you encountered situations with patients where you felt like you could not move forward without the assistance of other specialists such as a trained GI psychologist? 19:47   •    Chey and Scarlata on disordered eating and eating disorders and red flags to help identify and assist these patients. 22:25 •    Are you utilizing the FODMAP Gentle or bottom-up approach? 27:27 •    Berry, Chey and Scarlata on the emergence of digital automated tools developed to help patients get access to therapies without the use of a trained clinician. 29:11 •    Can you talk about the patient advocacy efforts you have been involved with, including the IBelieveinyourStory campaign and the EndHungerPain initiative? 34:43 •    Chey, Berry and Scarlata on the economic challenges facing multidisciplinary GI care and getting patients access to dietary needs including resources like Equip Health. 41:29 •    Scarlata on her upcoming book, Mind Your Gut: The Whole-body, Science-based Guide to Living with IBS, co-written with Megan Reihl, PsyD. 43:52 •    Thank you, Kate 45:06 •    Thanks for listening 45:17 Kate Scarlata, MPH, RDN is a US-based dietitian with over 30 years of experience. Kate’s expertise is in gastrointestinal disorders and food intolerance. Kate is the author of numerous books and articles on digestive health topics including the New York Times Best Seller, The 21 Day Tummy Diet. We’d love to hear from you! Send your comments/questions to [email protected]. Follow us on X, formerly known as Twitter, @HealioGastro @sameerkberry @umfoodoc. For more from Kate Scarlata, follow @KateScarlata_RD on X, formerly known as Twitter. Disclosures: Berry and Chey report no relevant financial disclosures. Scarlata reports stock options with Epicured LLC and FODY Food Company, financial support from Dr. Schar, Mahana Therapeutics, Nestle Health Science, Olipop, Pendulum, QOL Medical.

In this podcast episode, Tamara Duker Freuman, MS, RD, CDN, discusses how the work of gastroenterologists and dieticians can inform each other, approaching GI conditions as new science emerges and more. •    Intro :02 •    Welcome to this episode of Gut Talk :23 •    The interview/about Duker Freuman :30 •    How did your childhood environment and early education lead you to become a dietician? :41 •    Can you tell us about how your experiences have had an impact on the way you treat your patients as a dietician? 1:47 •    How Duker Freuman’s books, Bloated Belly Whisperer and Regular, provide information about clues that can help providers better understand the causes of patients’ symptoms. 3:22 •    Are dieticians trained differently than doctors when it comes to motivational interviewing versus fact-seeking to learn about patient history? 4:30 •    About the JAMA Network studies on Variations in Processes of Care and Outcomes for Hospitalized General Medicine Patients Treated by Female vs Male Physicians and Comparison of Hospital Mortality and Readmission Rates for Medicare Patients Treated by Male vs Female Physicians  7:12 •    What eventually drew you to dietetics, and then GI dietetics? 7:43 •    When you went into GI nutrition, was it already a recognized specialty? 10:52  •    Were you an early adopter of the low-FODMAP diet? 13:27 •    How did the GI community react to the news of low-FODMAP at the time? Was this science well-embraced by physicians when it came out? 14:50  •    With low-FODMAP, are you a top down or a bottom up person? Do you have a preference? 19:03 •    In your book you discuss the ten main causes for bloating. What are the main causes we should be thinking about, and which are the most common in your experience? 20:22 •    You talk about the “food baby twins”, gastroparesis and abdomino-phrenic dyssynergia, in your book. Can you tell us about that? 22:51 •    Do you have any recommendations for abdomino-phrenic dyssynergia, like diaphragmatic breathing, and what has worked that you have recommended to patients? 24:02 •    With the challenges of insurance reimbursement for dietetics and getting patients access to this type of information, can you provide enough value with one visit with a patient, or is multiple visits with a dietician required in order to move the needle? 25:19 •    What do you think about histamine intolerance? How do you identify it and is there a low-histamine diet that people can use now? … What about Mediterranean? 28:27 •    How have you trained yourself and the dieticians that you work with to think about and incorporate cultural and lifestyle sensitivity into dietary recommendations? Are there best practices to embrace that, or is this a challenge of dietetics? 36:01 •    What was it like joining New York Gastroenterology Associates (NYGA) when they became a large group practice? … What was it like bringing on additional dieticians and continuing to grow that part of NYGA’s care delivery? 39:40 •    Thank you, Tamara 43:41 •    Thanks for listening 43:59 Tamara Duker Freuman, MS, RD, CDN, is a New York-based registered dietitian, author and nationally-known expert on medical nutrition therapy for gastrointestinal diseases. We’d love to hear from you! Send your comments/questions to [email protected]. Follow us on Twitter @HealioGastro @sameerkberry @umfoodoc. For more from Tamara Duker Freuman, follow @tamaraduker on Twitter and @tamarafreuman on Instagram.   Disclosures: Berry, Chey, and Duker Freuman report no relevant financial disclosures. 

In this podcast episode, Douglas Rex, MD, discusses the importance of intent-to-treat for colorectal screenings, how screening technology has transformed gastroenterology practice and more. •    Intro :02 •    Welcome to this episode of Gut Talk :23 •    The interview/about Rex :32 •    Where did you grow up, and what was your childhood like?  :52 •    What got you interested in medicine? 2:50 •    How did your journey with GI start? 4:33 •    How have those early days and formidable experiences of being in the lab impacted your career today and what you are more well-known for? 8:19 •    Discussion on the NEJM study and the debates surrounding methodologies for endoscopy 11:55 •    Rex, Chey and Berry on the importance on the issue surrounding intent-to-treat in the setting of colorectal cancer screening 14:57 •    Rex on the Multi-Society Task Force of Colorectal Cancer (MSTF) committee and how they come to decisions that influence how gastroenterologists practice daily 16:55 •    Was it a difficult decision to move the threshold for colorectal cancer screening from 50 to 45? 20:41 •    In an environment where there is a limited resource such as colonoscopy, are you struggling with volume at your institution? … What are some strategies that listeners can utilize to prioritize patients, seek other possibilities and manage volume? 22:28 •    What’s the right way to approach the screening problem? … Where will this lead us ten years from now if all of us are spending our time in the endoscopy suite because of continued reduction in the age of screening while the prevalence of functional conditions and chronic diseases is also rising? 25:51 •    How long do you think we’ll continue to rely upon screening colonoscopy as one of our primary means by which to screen for colon cancer? Are there any technologies on the horizon that will eat into the share of screening colonoscopy? 28:55 •    What is your perspective on AI and how it can impact not only adenoma detection rate and polyp detection, but also clinical workflows such as documentation time? … Are you concerned about the new generation of clinicians being trained on and relying on these tools? 34:07 •    What have you learned in terms of best practices for the right and wrong ways to work with industry? 38:07 •    Thank you, Dr. Rex 40:25 •    Thanks for listening 40:43Douglas K. Rex, MD, is a distinguished professor emeritus at Indiana University School of Medicine and a full-time clinical gastroenterologist at Indiana University Hospitals. We’d love to hear from you! Send your comments/questions to [email protected]. Follow us on Twitter @HealioGastro @sameerkberry @umfoodoc. For more from Dr. Rex, follow @Rex_colonoscopy on Twitter.  Disclosures: Chey and Berry report no relevant financial disclosures. Rex is a consultant for Boston Scientific, Braintree Laboratories, Medtronic, Norgine, and Olympus Corporation. He provides research support at Braintree Laboratories, Erbe USA Inc, Medivators, and Olympus Corporation and is a shareholder of Satisfai Health.

In this podcast episode, Douglas Drossman, MD, and Johannah Ruddy MEd, discuss methods of destigmatizing chronic illness for patients and physicians, technology’s effect on the doctor-patient relationship and more.

•    Intro :02 •    Welcome to this episode of Gut Talk :23 •    The interview/about Drossman and Ruddy :30 •    About Ruddy’s professional and personal background regarding DGBI patients 1:40 •    For Ruddy: What was the transformative moment that made you want to get so involved in patient advocacy? 3:39 •    For Drossman: How do doctors talk more effectively to patients? 5:49 •    Chey and Drossman on the objectification of patients and physicians 9:00 •    Are there ways to teach people to re-inject the joy of the patient-physician interaction? … How do physicians re-frame the way that they think about interacting with patients? 10:00 •    Ruddy, Chey and Drossman on the value of narrative history taking 13:35 •    Drossman on the connection between psychosocial information and the onset and perpetuation of patient symptoms 15:29 •    Why are there such big gaps in care for patients with disorders of gut-brain interaction and visceral hypersensitivity? 16:00 •    About the Linedale study on clear language versus qualified language for IBS diagnoses 18:55 •    Chey on the flipsides of confident diagnoses 22:22 •    Do gastroenterologists and primary care doctors have the tools available to treat these conditions? 24:15 •    Thoughts on how technology has affected the physician-patient relationship 27:38 •    How do you deal with the systematic pressures that exist on most brick-and-mortar gastroenterologists today? 31:21 •    Tell us about the main goals and contents of your book, The Patient-Doctor Relationship and Gut Feelings: The Patient’s Story 32:38 •    What are the common threads that emerged from your studies in the book for doctors to think about? 34:03 •    Ruddy’s patient insights on where physicians can think about prioritizing in their care 36:47 •    Thank you, Dr. Drossman and Ms. Ruddy 38:33 •    Thanks for listening 39:14 Douglas Drossman, MD, is a professor emeritus of medicine and psychiatry in gastroenterology at UNC. He is a fellow of the American College of Physicians, a master of the American College of Gastroenterology, past-president of the American Psychosomatic Society. Johannah Ruddy, MEd, is an educator, researcher and writer and currently serves as the chief operating officer and executive director of the Rome Foundation. Ruddy co-founded and is the director of Tuesday Night IBS community on Twitter.      Check out: Gut Feelings: Disorders of Gut-Brain Interaction https://romedross.video/GutFeelingsWebsite and The Patient-Doctor Relationship and Gut Feelings: The Patient’s Story https://romedross.video/patient-story We’d love to hear from you! Send your comments/questions to [email protected]. Follow us on Twitter @HealioGastro @sameerkberry @umfoodoc. For more from Dr. Drossman, follow him on Twitter @DDrossman. For more from Ms. Ruddy, follow her on Twitter @JohannahRuddy.  Disclosures: Chey and Berry report no relevant financial disclosures. Drossman reports affiliation with Ardelyx, Rome Foundation. Ruddy reports affiliation with Biomerica, Mahana Therapeutics, Rome Foundation and Tuesday Night IBS.

In this podcast episode, Shivan Mehta, MD, MBA, MSHP, discusses behavioral economics in patients and clinicians, the entrance of non-traditional entities in the health care space and more.

• Intro :02
• Welcome to this episode of Gut Talk :23
• The interview/about Mehta :30
• How did you get to where you are now? What got you interested in medicine, and how did you end up with the role that you have today? :58
• Can you elaborate more on the people who had an influence on you? 3:10
• About behavioral economics 5:39
• Are there tried and true theories in behavioral economics around what works to change patient behavior? 9:25
• What about insurance companies with steerage? … Are there studies that show that those are different types of financial incentives, as opposed to paying someone? 15:45
• Have we seen, or is there research on the effect of, pricing something lower in patients’ decision making in health care? 19:25
• As an academic researcher and administrator, what do you think about the entrance of non-traditional entities in health care compared to the work that is being done by clinicians and at academic centers? 22:03
• Do you see the move from fee-for-service to quality care happening? 26:41
• Thoughts on the future of funding in health care 28:38
• What do you think about the physician’s role in current and future innovation? 31:32
• How do we create a generation of physicians who are thinking more innovatively and entrepreneurially? 34:51
• Thank you, Dr. Mehta 41:43
• Thanks for listening 41:50

Shivan Mehta, MD, MBA, MSHP, is associate chief innovation officer at Penn Medicine and associate professor of Medicine and Health Policy at the Perelman School of Medicine.

We’d love to hear from you! Send your comments/questions to [email protected]. Follow us on Twitter @HealioGastro @sameerkberry @umfoodoc. For more from Dr. Mehta, follow @Shivan_Mehtaon Twitter.

Disclosures: Chey and Berry report no relevant financial disclosures. Mehta serves on a clinical advisory board for Guardant Health and receives grant funding from the National Institutes of Health.